The duke criteria for infective endocarditis provides standardized diagnostic criteria for endocarditis. Pdf proposed modifications to the duke criteria for the. Ie disproportionately affects those with underlying structural heart disease and is increasingly associated with health care contact, particularly in patients who have intravascular prosthetic material. Give three examples of immunologic sequelae of infective endocarditis 4. It is the dedication of healthcare workers that will lead us through this crisis. Strict application of these criteria resulted in 1 of. New criteria for diagnosis of infective endocarditis.
The definition of ie is based on the modified duke criteria, including pathologic criteria evidence. The cause of negative blood cultures was prior antibiotic treatment in 11 patients and q fever endocarditis detected by positive serology in three. In the absence of classical features fever, cardiac murmur, and peripheral vascular stigmata the diagnosis of infective endocarditis ie may be. Infective endocarditis ie is a noncontagious infection of the endocardium and heart valves.
Modified dukes criteria for infective endocarditis. Diagnosis of ie relies on the duke criteria, which were originally described in 1994 and modified in 2000. Assesment of the duke criteria for the diagnosis of. Duke criteria for infective endocarditis durack dt, lukes as, bright dk. Aha scientific statement on infective endocarditis 2015. Criteria, definite infective endocarditis, possible infective endocarditis, not infective endocarditis. Newer imaging tests4dimensional computed tomography 4d ct, fluorodeoxy glucose positron emission tomography fdgpet, and leukocyte scintigraphyare increasingly used as alternative or adjunct tests for select patients. Assesment of the duke criteria for the diagnosis of infective.
Major diagnostic criteria positive blood culture for typical infective endocarditis organisms strep viridans or bovis, hacek, staph aureus without other primary site, enterococcus, from 2 separate blood cultures or 2 positive cultures from samples drawn 12 hours apart, or 3 or a majority of 4 separate cultures of blood first and last. List the risk factors for infective endocarditis ie. Value and limitations of the duke criteria for the diagnosis of infective. The accepted criteria for diagnosis of ie are the modified.
Historical sources of bacteraemia should be considered, such as indwelling vascular catheters, recent dental work, and intravenous drug use. Symptoms are often subtle and examination is often unrevealing, but may demonstrate car. Objectives the purpose of this study was to assess the value and limitations of duke criteria for the diagnosis of infective endocarditis ie. Infective endocarditis symptoms, diagnosis and treatment. Infective endocarditis remains a diagnostic challenge. A wide variety of pathogens may cause infective endocarditis, and some cases are culture negative. If both are positive, diagnosis is definite see evidence for exceptions.
Many studies have now demonstrated the superiority of the duke. Infective endocarditis cardiovascular disorders msd. The presentation, clinical course, and approach to treatment can vary widely based on. Pdf although the sensitivity and specificity of the duke criteria for the diagnosis of infective endocarditis ie have been validated by. Modified duke infective endocarditis criteria university of. Duke criteria for the diagnosis of endocarditis definite. The modified duke criteria are used to help establish a diagnosis of endocarditis. It is most commonly caused by bacterial and fungal infections, although non infective causes of endocarditis occur, this chapter will concentrate on infective causes.
Among patients with infective endocarditis ie, inhospital mortality. It is frequently caused by enterococci, staphylococcus aureus and c oagulase negative staphylococci. Infective endocarditis is a relatively uncommon disease with a high mortality rate. Healthcare related infections now account for 2530% of newly reported cases of endocarditis. Ie disproportionately affects those with underlying. Clinical criteria are 2 major, 1 major plus 3 minor or 5 minor criteria e. Duke criteria for infective endocarditis radiology. University of pennsylvania health system antimicrobial use. Proposed modifications to the duke criteria for the diagnosis of infective endocarditis. Infective endocarditis has an annual incidence of up to 10100,000 of the general population and carries a mortality of up to 30% at 30 days.
Typical microorganisms consistent with ie from 2 separate blood cultures s. The epidemiology of infective endocarditis has become more complex with todays myriad healthcare associated factors that predispose to infection. Although echocardiography is still the mainstay imaging test, it misses up to 30% of cases. Tee recommended as first test in the following patients. Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. Finally, adjustment of the duke criteria to require a mini mum of 1 major plus 1 minor criterion or 3 minor criteria as a floor to designate a case. A second time, prospectively, we applied the duke endocarditis service criteria to a further 5 patients affected with q fever endocarditis. Value and limitations of the duke criteria for the. Determine the appropriate laboratory tests and imaging necessary to aid in diagnosing ie.
Describe the treatment of infective endocarditis 8. Using the model of jones criteria for rheumatic fever, the duke criteria for infective endocarditis combine major and minor clinical criteria. What are the diagnostic criteria for endocarditis, and how are they used. Pathologic criteria are histological or culture confirmation ofpathologic criteria are histological or culture confirmation of vegetation or emboli. Prevention the endocarditis team diagnosis definition of the terms used in the esc 2015 modified criteria for diagnosis of ie, with modifications in main principles of prevention of infective endocarditis boldface 1. Utilization of specific echocardiographic findings. Main complications of leftsided valve infective endocarditis and their management 8. Retrospective case study in a tertiary pediatric hospital.
Positive blood culture results for ie and evidence of endocardial involvement from echocardiography, are the two major duke criteria. Diagnosis of infective endocarditis duke criteria empirically derived, retrospectively tested, prospectively validated has become standard for all current studies on infective endocarditis original data based solely on tte shortcomings of original criteria have led to recent proposed modifications. Infective endocarditis requiring intensive care unit stay is increasing, and nosocomial ie is frequently responsible. While the incidence currently appears to be falling, the absolute number of cases is likely to rise substantially as. Main complications of leftsided valve infective endocarditis and. Infective endocarditis complicating transcatheter aortic. Infective endocarditis ie is an infection involving the endocardial surface of the heart, including the valvular structures, the chordae tendineae, sites of septal defects, or the mural endocardium. This scientific statement for healthcare professionals from the american heart association is the 2015 update to the 2005 iteration on the same topic infective endocarditis ie in adults.
The duke diagnostic criteria have been validated in pathologically proven infective endocarditis, with sensitivity 80%8 and almost 100% specificity in patients with acute unexplained fever. The duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis. Presentation is often nonspecific and most commonly includes fever. Esc guidelines on infective endocarditis prevention.
Give three examples of vascular sequelae of infective endocarditis 5. The modified duke criteria stratify patients into the following categories. Diagnostic criteria and problems in infective endocarditis ncbi. Moreover, changes in pathogen prevalence,in particular a more common staphylococcal origin, have affected outcomes. Chapter 83 infective endocarditis and valvular disease.
The duke criteria should be used as overview of management of infective endocarditis in adults. The duke criteria for diagnosing infective endocarditis are specific. Unclassified pacific partnership 2016 2015 esc guidelines for the management of infective endocarditis. Between 1985 and 2001, 41 episodes of ie were documented in 40 children median. Infective endocarditis ie is a rare, lifethreatening disease that has longlasting effects even among patients who survive and are cured. For adequate diagnostic sensitivity, transesophageal echocardiography is the preferred modality used in patients designated highrisk or those in whom transthoracic. The recently proposed duke criteria were confirmed to be more sensitive than the former. Endocarditis modified duke criteria unclassified pacific partnership 2016 j am soc echocardiogr 2012. Echocardiogram supportive of infective endocarditis. Infective endocarditis european society of cardiology. Because sensitivity of the modified duke criteria for infective endocarditis and echocardiography is lower in cied endocarditis since it is harder to detect infection on the device electrode tip or endocardial areas in contact with the electrode tip, fdgpetct or radiolabeled leukocyte scintigraphy imaging is the preferred means for. Antibiotic treatment of infec tious endocarditis depends on whether the involved valve is native or.
Although the sensitivity and specificity of the duke criteria for the diagnosis of infective endocarditis ie have been validated by investigators from europe and the united states, several. Despite the widespread use of these criteria for the diagnosis of ie, there are considerable limitations, and a substantial proportion of patients fall into the possible ie category. Infective endocarditis complicating transcatheter aortic valve implantation taviie is a relatively rare condition with an incidence of 0. List 5 lab or investigative findings in bacterial endocarditis 7. Patients with infective endocarditis are a heterogenous group. The diagnosis of infective endocarditis relies on the modified duke criteria which comprises microbiologic, echocardiographic, and clinicallaboratory criteria baddour lm, wilson wr, bayer as, fowler vg, tleyjeh im, rybak mj, et al. Infective endocarditis ie is an infectious and inflammatory process of endothelial lining of the heart structures and valves. Management considerations in infective endocarditis. Pdf proposed modifications to the duke criteria for the diagnosis. Blood culture positivity not meeting major criteria durack dt, et al.